Benefits and risks of antiretroviral therapy for neurological impairment

[Guest guest]

Neurology. 2009 Jan 13;72(2):165-70.

Benefits and risks of stavudine therapy for HIV-associated neurologic

complications in Uganda.

Sacktor N, Nakasujja N, Skolasky RL, on K, Musisi S, A,

Katabira E, Clifford DB.Department of Neurology, s Hopkins Bayview

Medical Center, Baltimore, MD 21224, USA. sacktor@...

BACKGROUND: The frequency of HIV dementia in a recent study of HIV+

individuals at the Infectious Disease Institute in Kampala, Uganda, was 31%.

Coformulated generic drugs, which include stavudine, are the most common

regimens to treat HIV infection in Uganda and many other parts of Africa.

OBJECTIVE: To evaluate the benefits and risks of stavudine-based highly

active antiretroviral therapy (HAART) for HIV-associated cognitive

impairment and distal sensory neuropathy. The study compared

neuropsychological performance changes in HIV+ individuals initiating HAART

for 6 months and HIV- individuals receiving no treatment for 6 months. The

risk of antiretroviral toxic neuropathy as a result of the initiation of

stavudine-based HAART was also examined. METHODS: At baseline, 102 HIV+

individuals in Uganda received neurologic, neuropsychological, and

functional assessments; began HAART; and were followed up for 6 months.

Twenty-five HIV- individuals received identical clinical assessments and

were followed up for 6 months. RESULTS: In HIV+ individuals, there was

improvement in verbal memory, motor and psychomotor speed, executive

thinking, and verbal fluency. After adjusting for differences in sex, HIV+

individuals demonstrated significant improvement in the Color Trails 2 test

(p = 0.025) compared with HIV- individuals. Symptoms of neuropathy developed

in 38% of previously asymptomatic HIV+ patients after initiation of the

stavudine-based HAART. CONCLUSIONS: After the initiation of highly active

antiretroviral therapy (HAART) including stavudine, HIV+ individuals with

cognitive impairment improve significantly as demonstrated by improved

performance on a test of executive function. However, peripheral

neurotoxicity occurred in 30 patients, presumably because of stavudine-based

HAART, suggesting the need for less toxic therapy. PMID: 19139369